Oddly,
I’ve shared research and published literature on the topic of vaccination,
immunology and epidemiology for half a decade - but I have yet to provide a reason
as to why I currently choose an alternative schedule for my children.

Now,
there are many catchy posts and blogs out there that go on to list ‘x’-number
of reasons on why they don’t vaccinate – and this is nice for people looking
for a convenient list to compare their knowledge and beliefs against (or to
criticize the heck out of).

To
be honest, when people ask me why we do not give consent to vaccinate I don’t
know exactly what to say.

For
starters, which disease are they referring to?

For
some diseases, my reasons to decline overlap, some may only partially affect my
reason, while others are more prominent. Some vaccines are more easily declined then others based on the risks of
infection and the treatment involved
in recovery.

Another
reason of hesitation in addressing this question: most people expect some all-encompassing novel reason.

I’m
sorry, but that does not exist…at least, not that I’ve come across.

Some
people may expect me to say vaccines don’t work, but I don’t believe that in
the slightest. In fact, with each
national vaccine campaign, epidemiology (and herd immunity) is modified in
varying degrees, benefiting some while actually placing another group at higher risk than before.[*][*][*]

Ultimately,
I have many reasons why I choose I decline, and the reasons may be modified depending on the disease.

In
this post, I want to address the ever-so-popular confrontational question, “Why
don’t you vaccinate”, in a very specific
approach. Each disease will be discussed separately from medical and
governmental sources. I will also provide a brief reason why I decline that
particular vaccine for the recommended age group.

(My
daughters are healthy children with no
underlying medical conditions. I have no family history adverse vaccine
reactions. The reasons listed are my own. I recommend anyone interested in this
subject to learn more about informed vaccine choices
and to ask their medical provider to furnish literature to review prior to the administration of any
pharmaceutical medication.)

Hepatitis B

Viral infection of the liver

The
Hepatitis B vaccine was one of the easiest vaccines to decline based purely on
the risk of the disease to my newborn and waning protection over time.

Hepatitis
B is a virus that infects the liver. The incubation period ranges from 45 to
160 days. Clinical signs and symptoms
occur more often in adults than in infants or children, who usually have an
asymptomatic acute course.Approximately
50% of adults who have acute infections are asymptomatic. [*]

Initial
symptoms may include an onset of jaundice which usually lasts from 3 to 10
days. The icteric phase is variable but usually lasts from 1 to 3 weeks and is
characterized by jaundice and light or gray stools. [*]

Approximately
5% of all acute HBV infections progress to chronic infection. [*]

While
most acute HBV infections in adults result in complete recovery, fulminant hepatitis (a rare and fatal form of
acute hepatitis B) occurs in about 1% to 2% of acutely infected persons. [*]

Approximately
90% of infants who acquire HBV infection from their mothers at birth become
chronically infected. This is way all
pregnancy mothers are tested prenatally for hepatitis infection.
Transmission from mother to infant is prevented by giving the infant HBIG
(Hepatitis B Immune Globulin). [*]

Hepatitis B is spread when
blood, semen, or other body fluid infected with the Hepatitis B virus enters
the body of
a person who is not infected.

People
can become infected with the virus during activities such as:

•Birth
(spread from an infected mother to her baby during birth)

•Sex
with an infected partner

•Sharing
needles, syringes, or other drug-injection equipment

•Sharing
items such as razors or toothbrushes with an infected person

•Direct
contact with the blood or open sores of an infected person

•Exposure
to blood from needles or other sharp instruments

Risk/Prevalence:

The
three major risk groups (according to the CDC):

•heterosexuals
with contact with infected persons or multiple partners

•injection-drug
users

•men
who have sex with men)

These
populations are not reached effectively by targeted programs, so a new strategy to eliminate hepatitis B was
recommended in 1991 which included prenatal testing routine vaccination of
infants. [*]

Among
children age 6-19 years, just about 50%
showed markers of vaccine-induced immunity, with little difference across
racial/ethnic groups.[*]

Hepatitis
B vaccination-induced protective antibodies can last for up to 15 years, but
appears to fall off over time when they
are more likely to be at risk.[*]

In
one study, in just 5 years, efficacy
of the vaccine fell to 67%.[*]

The
most common adverse reaction following hepatitis B vaccine is pain at the site
of injection. Hepatitis B vaccine has been alleged to cause or exacerbate
multiple sclerosis (MS). A 2004 retrospective study in a British population
found a slight increase in risk of MS among hepatitis B vaccine recipients.[*]

Treatment:

More
than 95% of people who become infected as adults or older children will stage a
full recovery and develop protective
immunity to the virus. Of those infected between the age of one to six, 70%
will clear the infection. [*]

There
is no medication available to treat acute Hepatitis B. During this short-term
infection, doctors usually recommend rest, adequate nutrition, and fluids,
although some people may need to be hospitalized. [*]

Rotavirus

Stomach flu

The risks of complications due to rotavirus are extremely
low. These risks are lowered further when, according to some research, the
duration of breastfeeding is extended.

Also, although the rotavirus vaccine is recommended by the
Advisory Committee on Immunization Practices (ACIP), it is not mandated in any
state.

We declined this vaccine because the risk of moderate to severe
complication and death from rotavirus are not enough for us to risk adverse
reaction to vaccination (not even if the risk is rare).

The incubation period for rotavirus diarrhea is short,
usually less than 48 hours. The clinical manifestations of infection vary and
depend on whether it is the first infection or reinfection. The first infection
after 3 months of age is generally the most severe. [*]

Infection may range
from asymptomatic to self-limited watery diarrhea, or may result in severe
dehydrating diarrhea with fever and vomiting. Up to one-third of infected
children may have a temperature greater than 102°F (39°C). The gastrointestinal
symptoms generally resolve in 3 to 7 days. [*]

The disease is more prevalent during fall and winter. The
reason for this seasonal pattern is unknown. [*]

Transmission:

The virus is transmitted by the faecal-oral route (via
contact with contaminated hands, surfaces and objects). It infects and damages
the cells that line the small intestine and causes gastroenteritis (which is
often called "stomach flu" despite having no relation to influenza).
[*]

Risk/Prevalence:

Infection with rotavirus is nearly universal, with almost all children infected by 5 years of age.
A vaccine to prevent rotavirus gastroenteritis was first licensed in August
1998 but was withdrawn in 1999 because of its association with intussusception.
Second-generation vaccines were licensed in 2006 and 2008. [*]

Approximately 37 death
per year before the vaccine was introduced. Rotavirus is not a
reportable disease so current mortality data is not available. [*]

Rotavirus infection is more prevalent during fall and
winter.The reason for this seasonal pattern is unknown. [*]

Infants younger than 3 months of age have relatively low
rates of rotavirus infection, most likely due to of passive maternal antibody
and breastfeeding. [*]

Groups at increased risk for rotavirus infection are those
with increased exposure to virus. These include children in hospital wards
(nosocomial rotavirus), young children attending day care centers, and elderly
people in nursing homes.[*][*]

Protection from the
vaccine:

The immune correlates
of protection from rotavirus are poorly understood. [*]

After completion of a three-dose RV5 regimen, the efficacy of
rotavirus vaccine against rotavirus gastroenteritis of any severity was 74%. [*]

Rotavirus is usually an easily managed disease of childhood. Treatment includes hydration. The WHO
also recommends zinc supplementation. [*]

Rotavirus infections rarely
cause other complications and for a well-managed child the prognosis is excellent.[*]

Other protective
effects:

Breast feeding

There is evidence of a protective concurrent effect of
breastfeeding against rotavirus infection in infants, particularly in children
6 months and younger.[*]

Earlier studies in relation to breastfeeding and the
rotavirus indicated that the duration of
breastfeeding was important in protection. [*]

Epithelial barrier integrity, known to be superior in the breastfed
infant as compared to the bottle-fed infant, promotes epidermal growth factor
strengthen epithelial barrier development. It is thought by some that the integrity of the intestinal mucosa maybe a
significant factor that may protect from potentially invasive rotaviral disease.[*]

Diphtheria

Toxin-mediated bacterial
infection

The
low prevalence of diphtheria in the US (2 cases in the 21st century, last of
which was 2003 – see below for reference) is one major factor in deciding to
decline this part of the combination vaccine. The risk of my daughter(s)
contracting diphtheria and exhibiting symptoms is very small.

The
waning protection of the vaccine is also of concern.

I
choose not to place my daughters at risk for known/unknown vaccine adverse
effects (DTaP or Tdap) purely for the sake of herd immunity against diphtheria,
especially if the effectiveness of the vaccine will wane substantially after 10
years and dependence of boosters throughout life are apparent.

If
my daughters decide to vaccinate themselves when they are older against
diphtheria, that is their choice. Right now, it is my responsibility to assess
the risk of disease and the benefits of this vaccine until they can do that for
themselves.

Diphtheria is an infectious disease spread by direct physical
contact or breathing the aerosolized secretions of infected individuals.[*]

Human carriers are the reservoir for C. diphtheriae and are usually asymptomatic. In outbreaks, high percentages of children are found to
be transient carriers (one who harbors disease organisms in their body without
manifest symptoms). [*]

Risk/Prevalence:

Diphtheria occurs worldwide, but clinical cases are more
prevalent in temperate zones. In the United States during the pre-toxoid era,
the highest incidence was in the Southeast during the winter. [*]

In the US, there were 53 reported cases of diphtheria between
1980 and 2000, only a total of 2 cases
of diphtheria have been reported in the 21st century, the last of which was in
2003. [*]

The overall case-fatality
rate for diphtheria is 5%–10%, with higher death rates (up to 20%) among
persons younger than 5 and older than 40 years of age. The case-fatality rate
for diphtheria has changed very little during the last 50 years. [*]

The diphtheria cases recently reported in Eastern Europe
illustrate a waning immunity to diphtheria among many adults.[*]

Treatment:

Antibiotics are used in patients or carriers to eradicate C.
diphtheriae and prevent its transmission to others (metronidazole,
erythromycin, procaine penicillin G). [*]

Persons with suspected diphtheria should be given antibiotics and antitoxin in adequate dosage and placed in isolation after the provisional
clinical diagnosis is made and appropriate cultures are obtained. Respiratory
support and airway maintenance should also be administered as needed. [*]

Tetanus

On average, there are 29 cases of tetanus reported annually
(see below for reference). Given this and the information that 75% of the
deaths in the US are patients older than
60 years, tetanus is not a vaccine we consider for my daughter’s age group.

To add, the tetanus component to the vaccine seems to be more
adverse then the other components (pertussis, diptheria). This, in combination
with the lack of evidence on efficacy of the tetanus toxoid, we currently decline.

No vaccine is available in the US for tetanus alone however,
vaccination for tetanus in children is recommended in a combination vaccine in
conjunction with pertussis and tetanus (Tdap, DTap) or
tetanus alone (Td).
For those who have contradictions to aP, TD is recommended.

The adult booster for tetanus also combines diphtheria (Td).

The Disease:

Tetanus is an acute, often fatal, disease caused by an
exotoxin produced by the bacterium Clostridium tetani. It is characterized by
generalized rigidity and convulsive spasms of skeletal muscles. The muscle
stiffness usually involves the jaw (lockjaw) and neck and then becomes
generalized.[*]

C. tetani usually enters the body through a wound. In the
presence of anaerobic (low oxygen) conditions, the spores germinate. [*]

The typical clinical manifestations of tetanus are caused
when tetanus toxin interferes with release of neurotransmitters, blocking
inhibitor impulses. This leads to unopposed muscle contraction and spasm. [*]

The time between an injury and the occurrence of the first
symptoms is typically less than two weeks but may range from 5 days to 15
weeks. [*]

Infection generally occurs through wound contamination and often involves a cut or deep puncture wound.[*]

Transmission:

Tetanus is not contagious from person to person. It is the only vaccine-preventable disease
that is infectious but not contagious. [*]

Organisms are found primarily
in the soil and intestinal tracts of animals and humans. [*]

Transmission is primarily by contaminated wounds. The wound
may be major or minor. In recent years, however, a higher proportion of
patients had minor wounds, most likely because severe wounds are more likely to
be properly managed and cleaned. Tetanus may follow elective surgery, burns,
deep puncture wounds, crush wounds, otitis media (ear infections), dental
infection, animal bites, abortion, and pregnancy. [*]

From 1998-2000, 75% of the deaths in the US were in patients older than 60 years.[*]

Heroin users,
particularly persons who inject themselves subcutaneously, appear to be at high
risk for tetanus. [*]

From 2001 - 2008, the last years for which data have been
compiled, a total of 233 tetanus cases was reported, an average of 29 cases per
year. Among the 197 cases with known outcomes the case-fatality rate was 13%. [*]

Tetanus occurs worldwide but is most frequently encountered
in densely populated regions in hot,
damp climates with soil rich in organic matter. [*]

Protection from the
vaccine:

Efficacy of the tetanus toxoid has never been studied in a vaccine trial. [*]

Because of waning antitoxin titers, most persons have
antitoxin levels below the optimal level 10 years after the last dose of DTaP,
DTP, DT, or Td. Additional booster doses of tetanus and diphtheria toxoids are
required every 10 years to maintain protective antitoxin titers. The first
booster dose of Td may be given at 11 or 12 years of age if at least 5 years
have elapsed since the last dose of DTaP, DTP, or DT. The Advisory Committee on
Immunization Practices (ACIP) recommends that this dose be administered as
Tdap. [*]

Severe systemic
reactions such as generalized urticaria (hives), anaphylaxis, or neurologic
complications have been reported after receipt of tetanus toxoid.A few cases of peripheral neuropathy and Guillain-Barré syndrome (GBS)
have been reported following tetanus toxoid administration. [*]

Exaggerated local reactions are occasionally reported
following receipt of a diphtheria- or tetanus-containing vaccine. These
reactions present as extensive painful swelling, often from shoulder to elbow.
They generally begin 2–8 hours after injections and are reported most often in
adults. [*]

Rarely, severe systemic reactions such as generalized
urticaria, anaphylaxis, or neurologic complications have been reported
following administration of diphtheria toxoid. [*]

Treatment:

Immune globulin, given intramuscularly, is the immediate
treatment of unimmunized individuals exposed to material likely to contain the
tetanus bacteria. Treatment includes bed rest and quiet conditions.
Antimicrobial drugs, such as penicillin, are used to eradicate the bacteria.[*]

A single intramuscular dose of tetanus immune globulin
(TIG)(3,000 to 5,000 units) is
generally recommended for children and adults, with part of the dose
infiltrated around the wound if it can be identified. [*]

Pertussis

Whooping Cough

The
DTaP vaccine was more challenging to decline when my girls were younger (less
then 12 months old). Pertussis infection can be very serious in infants and the
vaccine can lessen symptoms if the disease is contracted.

My
girls are older now and because clinical manifestation of the disease is age
dependent,I give less consideration to
the disease then I did in the past.

The
risk of my children (when they were younger than 12 months) of dying from
pertussis was still very low without the vaccine (0.000004%), this reason in
combination with the evidence that vaccinated children show an increase in the
colonization of parapertussis (40-fold increase) in the lungs compared to those
unvaccinated – we currently declined this vaccine.

This
is definitely not one of the easier choice vaccines to decline. I continue to
re-visit the published literature on the aP (acellular pertussis) vaccine and
the epidemiology of pertussis and parapertussis infection within the United
States.

Booster of Tdap to pregnant mothers during each pregnancy (3rd
trimester).

The Disease:

Pertussis, commonly called whooping cough — is a highly contagious bacterial disease caused
most commonly by Bordetella pertussis, though Bordetella parapertussis has also been associated with
this condition in humans.[*]

The infection with B. pertussis results in a wide spectrum of
clinical manifestations, depending on
the age and immune status of the host, and ranges from mild respiratory
symptoms to a severe cough illness, which may be accompanied by the
hallmark inspiratory whoop.[*]

The incubation period of pertussis is commonly 7–10 days. The
clinical course of the illness is divided into three stages:[*]

The catarrhal stage: characterized by the onset of a runny
nose, sneezing, low-grade fever, mild coughing - similar to the common cold.
Lasting approximately 1-2 weeks. [*]

The paroxysmal stage: Fever is generally minimal throughout
the course of the illness, the cough gradually becomes more intense. [*]

The paroxysmal stage: It is during this stage that the
diagnosis of pertussis is usually suspected. Characteristically, the patient
has bursts of numerous, rapid coughs, apparently due to difficulty expelling
thick mucus from the tracheobronchial tree. At the end of the paroxysm, a long inspiratory
effort is usually accompanied by a characteristic high-pitched whoop. [*]

Many people do not
develop the characteristic whoop. Sometimes, a persistent hacking cough is the only sign that
an adolescent or adult has whooping cough.[*]

Recovery is gradual. The cough becomes less paroxysmal and
disappears in 2 to 3 weeks. [*]

The most common complication, and the cause of most
pertussis-related deaths, is secondary bacterial pneumonia. Young infants are
at highest risk for acquiring pertussis-associated complications. [*]

Transmission:

B. pertussis is a strict human pathogen with no known animal
or environmental reservoir, maintenance of the organism within the population
is thought to require continuous transmission of the disease from infected to
naive hosts. [*]

Pertussis is often described as being highly infectious (with
household contact studies showing an infection rate between 58% and 100%).

Although pertussis is typically described as being highly
infectious, efficient transmission requires close contact or prolonged exposure. [*]

As expected for an airborne exposure, the rate of
transmission is dependent upon distance between the infected and naive
individual.[*]

Risk/Prevalence:

Before the vaccine was developed, whooping cough was
considered a childhood disease. Now whooping cough primarily affects children
too young to have completed the full course of vaccinations and teenagers and
adults whose immunity has faded. [*]

With greater than 27, 000 reported cases in the United States
in 2010, the highest number since the 1950s, pertussis is the most commonly occurring vaccine-preventable disease.
This resurgence is occurring throughout the industrial world despite similar
high rates of vaccination.[*]

Deaths associated with
whooping cough are rare but most commonly occur in infants.[*]

The protective power of the diphtheria, tetanus, acellular
pertussis vaccination (DTaP) wanes with time.Each year that elapses after
vaccination is associated with a 36% increased risk of acquiring pertussis.
[*]

The waning protection of the vaccine is one reason why was
have been witnessing a gradually increasing since the early 1980s.[*]

Another reason: Although this disease is most often
attributed to Bordetella pertussis infection, it is also caused by the closely
related pathogen, B. parapertussis. Acelluar
pertussis vaccination has been documented in leading to a 40-fold
enhancement of B. parapertussis colonization in the lungs of mice.[*][*]

As with all injected vaccines, administration of DTaP may
cause local reactions, such as pain, redness, or swelling. Local reactions have
been reported in 20%–40% of children after the first three doses. Local
reactions appear to be more frequent after the fourth and/or fifth doses. Mild
systemic reactions such as drowsiness, fretfulness, and low-grade fever may
also occur. [*]

Swelling involving the entire thigh or upper arm has been
reported after booster doses of certain acellular pertussis vaccines. The limb
swelling may be accompanied by erythema, pain and fever. Although the swelling
may interfere with walking, most children have no limitation of activity. The pathogenesis and frequency of
substantial local reactions and limb swelling are not known. [*]

Treatment:

The medical management of pertussis cases is primarily
supportive. [*]

Treatment for older children and adults usually can be
managed at home.[*]

Infants are typically hospitalized for treatment because
whooping cough is more dangerous for that age group. If your child can't keep
down liquids or food, intravenous fluids may be necessary. Your child will also
be isolated from others to prevent the infection from spreading. [*]

Antibiotics kill the bacteria causing whooping cough and help
speed recovery. Family members may be given preventive antibiotics. [*]

-Vaporize the room (soothe irritated lungs and to help loosen
respiratory secretions)

-Breathe clean the air (keeping your home free of irritants
that can trigger coughing spells, such as tobacco smoke)

Haemophilus
B

Hib

The
most recent data I was able to obtain on invasive Hib infection was from 2009.
That year, 35 children (younger than 5 years) died from invasive Hib infection.

Coupling
the low risk of death from Hib infection with the other factors that do not
make my children high risk (see below for risk factors and the role long term
breastfeeding has on infection), we currently decline this vaccine.

According
to the CDC (see below for reference), in the prevaccine era, the majority of
children acquired immunity by 5–6 years of age through asymptomatic infection by Hib bacteria.

The
vaccine is not recommended for those over 5 yrs of age, my oldest who is
approaching 5 years old will not be a candidate for this vaccine in a few
months. This makes the choice to decline more straightforward as well.

Hib vaccine is not routinely recommended for patients older
than 5 years of age.[*]

The Disease:

Most strains of Haemophilus influenzae bacteria, including
Hib, usually live in a person’s nose or throat without causing disease. Severe infections can result when the
bacteria invade parts of the body that are normally free from germs, like blood
or spinal fluid. This is known as "invasive disease."[*]

Since the introduction of Hib conjugate vaccines in the
1990s, the epidemiology of invasive H
influenzae disease has changed substantially, with most infections now caused by non-Hib strains. [*]

The most striking feature of Hib disease is age-dependent susceptibility. Hib
disease is not common beyond 5 years of
age (however, this epidemiology is changing due to the vaccination of
infants, see below for more detail). In
the prevaccine era, most children acquired immunity by 5–6 years of age through
asymptomatic infection by Hib bacteria. [*]

Transmission:

Humans (asymptomatic carriers) are the only known reservoir.
Hib does not survive in the environment on inanimate surfaces. The primary mode
of Hib transmission is presumably by respiratory droplet spread, although firm evidence for this mechanism
is lacking. [*]

Several studies in the prevaccine era described a bimodal
seasonal pattern in the United States, with one peak during September through
December and a second peak during March through May. The reason for this
bimodal pattern is not known. [*]

The contagious potential of invasive Hib disease is
considered to be limited. However, certain circumstances, particularly close
contact with a case-patient (e.g., household, child care, or institutional
setting) can lead to outbreaks or direct secondary transmission of the disease.
[*]

Risk/Prevalence:

In 2009, among children younger than 5 years of age, 35 cases of invasive disease due to Hib
were reported in the United States. [*]

Although the reduction in carriage achieved by conjugate
vaccines is beneficial from the perspective of herd immunity, it has raised
concerns about the possibility of
serotype replacement.[*]

Because the protection offered by conjugate vaccines is
specific to the capsular type(s) included in the vaccine, it has been suggested
that reducing carriage of these vaccine types may leave open an ecologic niche that will be filled by serotypes not included in
the vaccine. [*]

As the prevalence of Hib has decreased, other encapsulated serotypes seem to have emerged as major causes of
invasive disease.[*]

Strain replacement of Hib with serotype f and non-typeable
strains in children under 5 years has been documented. [*]

Also, invasive H. influenzae infection, once a childhood
concern, has now been documented in
disproportionately affecting the elderly and is associated with a high
mortality rate.[*]

Although vaccination of infants resulted in an initial
decline in Hib infections in adults, a resurgence in reported cases occurred in
2002-3. Childhood vaccination programsmay have unanticipated effects on
the epidemiology of Hib disease in older age groups.[*]

The incidence of H. influenzae invasive disease has shifted toward adults. In a study
conducted in the Atlanta, Georgia, USA, metropolitan area before Hib vaccine
introduction, adults comprised 24% of all invasive H. influenzae cases (6). A
more recent population-based report from Illinois showed adults accounting for
77% of invasive cases. [*]

Most (51%) invasive
disease occurred in persons [greater than or equal to] 65 years of age. [*]

A vaccine, like any medicine, is capable of causing serious
problems, such as severe allergic reactions. The risk of Hib vaccine causing
serious harm or death is extremely small.[*]

Treatment:

When Haemophilus influenzae bacteria causea a non-invasive
infection, like bronchitis or an ear infection, complications are rare and
typically not severe. If appropriate, antibiotics will be given to prevent
complications.[*]

Hospitalization is generally required for invasive Hib
disease. Antimicrobial therapy with an effective third-generation cephalosporin
(cefotaxime or ceftriaxone), or chloramphenicol in combination with ampicillin
should be begun immediately. The treatment course is usually 10 days.[*]

As for invasive Hib B infection, the complications can be
different. For example, if meningitis occurs, a person can suffer from brain
damage or hearing loss. Bacteremia (blood infection) can result in loss of
limb(s). [*]

Other protective
effects:

Breast feeding

There is a long-lasting
protective effect of breastfeeding on the risk for invasive Hib infection.
Data has shown adecreased risk for
invasive Hib infection with long duration of breastfeeding.[*][*]

The colonization of H. influenzae in the throat is inhibited by the presence of breast milk.[*]

Streptococcus
Pneumoniae

Pneumonia

Several other parents I know that follow a delayed/select
vaccine schedule choose to include Prevnar 13. The vaccine has been very
effective at modifying epidemiology
of infection of the 13 strains (out of the 80 circulating) it currently includes.

Out of all vaccines available, this is the one that I would
most likely administer (if I had to
pick one).

We choose to decline Pzifer’s Prevnar 13 product because the
risk of my daughters becoming seriously ill from this disease is very low (they
do not have any pre-existing conditions that place them at high risk of
invasive infection). We also consider that up to 70% of adults are
asymptomatic carriers and the
relationship between antibody titer and protection from pneumococcal invasive
disease is still not certain.

We also consider that there is the lack of clinical safety
data to review comparing the vaccine against a placebo group and the severe
adverse reaction rate. According to the clinical safety data from the
manufacturer,
8.2% of infants and toddlers reported severe
reactions after 1-dose vaccination. A child will be administered this
product 4 times (if vaccinating on schedule). The manufacturer’s clinical data did not utilize a saline placebo group
in establishing safety, Prevnar 13 was tested against Prevnar 7.

Routine vaccination with Pneumococcal conjugate vaccine (PCV-13)
is recommended ages 2, 4, 6 months with a booster at age 12 through 15 months.
(Unvaccinated children 7 months of age or older require fewer doses)

Booster vaccination with Pneumococcal polysaccharide vaccine
(PPSV23)
is recommended at age 65 or older. A booster is also recommended starting at
age 19 if a person smokes or has asthma.[*]

The Disease:

Pneumonia has many possible causes. The most common are
bacteria and viruses in the air we breathe. A person’s body usually prevents
these germs from infecting the lungs but sometimes these germs can overpower
the immune system.[*]

Symptoms of pneumococcal infection include sudden onset of
fever and fatigue, sneezing and cough with mucus and shortness of breath. The
infection may start with start with a general feeling of being unwell, a low
grade fever and a cough that doesn’t include mucus before symptoms worsen.
Symptoms of pneumococcal meningitis (brain inflammation) include stiff neck
(inability to touch the chin to chest without moderate to severe pain in the
back of the neck and head); headache; extreme fatigue or seizures. [*]

The major clinical syndromes of pneumococcal disease are
pneumonia, bacteremia, and meningitis.
The immunologic mechanism that allows disease to occur in a carrier is not
clearly understood. However, disease
most often occurs when a predisposing condition exists, particularly pulmonary
disease. [*]

The relationship between
antibody titer and protection from pneumococcal invasive disease is not certain. [*]

Transmission:

S. pneumoniae is a human pathogen. Transmission of S.
pneumoniae occurs as the result of direct person-to-person contact via
respiratory droplets and by autoinoculation (autoinoculation means to “self
spread”- aka spreading the bacteria to another part of your body) in persons
carrying the bacteria in their upper respiratory tract. [*]

Pneumococci are common inhabitants of the respiratory tract .
The carrier rate in asymptomatic healthy
adults varies between 40% and 70%.[*][*]

Rates of asymptomatic carriage vary with age, environment,
and the presence of upper respiratory infections. Only 5%–10% of adults without
children are carriers. [*]

Pneumococcal infections are more common during the winter and
in early spring when respiratory diseases are more prevalent. [*]

Before introduction of PCV7, rates of PC7-type invasive
pneumococcal disease among children in this age were around 80 cases per
100,000 population (0.0008%).After the introduction of PCV7, rates of
disease due to these 7 serotypes dropped dramatically to less than 1 case per
100,000 (0.00001%).[*]

Approximately 10% of all patients with invasive pneumococcal
disease die of their illness, but case-fatality
rates are higher for the elderly and patients with certain underlying
illnesses. [*]

Children with functional or anatomic asplenia, particularly
those with sickle cell disease, and children with human immunodeficiency virus
(HIV) infection are at very high risk for invasive disease, with rates in some
studies more than 50 times higher than those among children of the same age
without these conditions. [*]

Rates are also increased among children of certain racial and
ethnic groups (Alaska Native, African American, and certain American Indian
groups). The reason for this increased risk by race and ethnicity is not known. [*]

Attendance at a child care center has also been shown to
increase the risk of invasive pneumococcal disease among children younger than
59 months of age. [*]

Protection from the
vaccine:

Data from the Active Bacterial Core surveillance (ABCs)
system suggest that the use of pneumococcal conjugate vaccine has had a major
impact on the incidence of invasive disease among young children.

However, there is
evidence that mass use of the PCV-7 vaccine placed pressure on some of the 80
other pneumococcal strains to cause invasive disease and was responsible
for increasing the rates of otitis media caused by serotypes not included in the seven-valent vaccine,
particularly the 19A strain.[*][*][*][*][*]

To alleviate this problem, a new vaccine replaced the PCV7 to
include serotype 19A (PCV13).

The PPSV23 booster, shows antibody levels declining after 5–10 years (and decrease more
rapidly in some groups than others). In fact, this vaccine does not produce a sustained increase (“boost”) in antibody
titers. Available data does not indicate a substantial increase in
protection in the majority of revaccinated persons. [*]

Despite multiple studies conducted during >30 years, the efficacy and effectiveness of 23-valent
pneumococcal polysaccharide vaccine (PPSV) in children and adults remain poorly
defined and the subject of controversy. Furthermore, repeated doses of PPSV are associated with hyporesponsiveness, when
antibody levels after a second antigenic challenge arelower than after the first administration.[*]

Local reactions (such as pain, swelling or redness) following
PCV13 occur in up to half of recipients. [*]

Approximately 8% of
local reactions are considered to be severe (e.g., tenderness that
interferes with limb movement). [*]

The manufacturer product insert indicates that when Prevnar
is given at the same time as HIB, pertussis and polio vaccines, it may lower the efficacy of those vaccines
for some children. There is no data on what happens when Prevnar vaccine is
given in combination with MMR or chicken pox vaccines.[*]

Treatment:

Resistance to penicillin and other antibiotics is common. In
some areas of the United States, up to 40% of invasive pneumococcal isolates
are resistant to penicillin. Treatment will usually include a broad-spectrum
cephalosporin, and often vancomycin, until results of antibiotic sensitivity
testing are available. [*]

Breastfeeding inhibits
the attachment of Streptococcus pneumoniae and Haemophilus influenzae.[*]

Poliomyelitis

Polio

As of 1994, wild-type polio has been declared eradicated in
the Western Hemisphere – this provides a very minimal risk for my daughters (or
myself) to be exposed to the polio virus and/or exhibit symptoms and/or suffer
adverse complications.

We currently do not travel internationally (or to those
countries that have polio in circulation).

These reasons, coupled with the understanding that most all (95%)
polio infections are inapparent/asymptomatic – we currently decline this
vaccine.

Routine vaccination includes administration of inactivated
poliovirus vaccine (IPV) at ages
2, 4, 6–18 months, with a booster at age 4–6 years.

The Disease:

Poliomyelitis is a viral disease that can affect nerves and
has the potential to lead to partial or full paralysis.[*]

The response to poliovirus infection is highly variable,
there are three basic patterns of polio infection: subclinical infections,
nonparalytic, and paralytic. Approximately, 95% of all polio infections are inapparent or asymptomatic. [*][*]

Humans are the only known reservoir of poliovirus, which is
transmitted most frequently through contact with stool of an infected person
(known as fecal-oral transmission) with inapparent infections. [*][*]

Less frequently, polio transmission can occur through contact
with infected respiratory secretions or saliva (oral-oral transmission).

•Eating food or drinking liquids that are contaminated with
poliovirus. Poliovirus is commonly found in sewage water.

•Touching surfaces or objects contaminated with poliovirus
(for example, when changing diapers), and then placing the contaminated hand in
the mouth.

The virus enters through the mouth, and primary multiplication
of the virus occurs at the site of implantation in the pharynx and
gastrointestinal tract. [*]

The incubation period for poliomyelitis is commonly 6 to 20
days with a range of 3 to 35 days. [*]

Risk/Prevalence:

Polio is eradicated in most parts of the world (except for
three countries Afghanistan, Nigeria and Pakistan). [*]

In 2012, about 220 cases were reported worldwide, and almost
all were in these 3 countries. [*]

In September 1994, an international commission certified the Western Hemisphere to be free of
indigenous wild poliovirus. [*]

From 1980 through 1999, a total of 152 confirmed cases of
paralytic poliomyelitis were reported in the US. 95% of these cases were vaccine-associated paralytic polio (VAPP)
caused by live oral polio vaccine. [*]

In order to eliminate VAPP from the United States, ACIP
recommended in 2000 that IPV be used exclusively in the United States. [*]

The death-to-case ratio for paralytic polio is generally
2%–5% among children and up to 15%–30% for adults (depending on age). [*]

Fewer than 1% of all polio infections result in flaccid
paralysis. [*]

The efficacy of 2 doses of IPV is 90% after 2 doses, 99%
after 3 doses. [*]

As for the OPV, theoretically, one may require 10-15 doses of
OPV to reach near 100% efficacy (children under 5 years in northern India had
received on average 19 doses of OPV).[*]

One major challenge to the wild poliovirus eradication is the
poor immunogenicity of OPV in lower-income countries. Routine schedules where
four or five doses of trivalent OPV are administered are not always
sufficiently protective.[*]

Research into the causes of OPV failure and interventions to
improve its immunogenicity is ongoing.
[*]

Since IPV contains trace amounts of streptomycin, neomycin,
and polymyxin B, there is a possibility of allergic reactions in persons
sensitive to these antibiotics. [*]

Treatment:

The goal of treatment is to control symptoms while the
infection runs its course. [*]

The treatment and outlook depend on the form of the disease
(subclinical >95%, or paralytic 1-2%) and the body area affected. [*][*]

Symptoms are treated based on their severity. Treatment may
include: [*]

The
safety data on the influenza vaccine is severely limited in children (despite
the CDC’s recommendation to vaccinate children 6 months and older). I also find
the mounting evidence that repeat exposure to the vaccine increases other
non-influenza respiratory illness, to say the least, very discouraging.

Approximately
all influenza related deaths (90%) occur in persons that are 65 years and
older.

My
children have no pre-existing conditions (such as asthma or immune-compromised
illness).

These
factors converge and reinforce our decision not to administer this vaccine.

Following respiratory transmission, the influenza virus
attaches to and penetrates respiratory epithelial cells in the trachea and
bronchi. Viral replication occurs, which results in the destruction of the host
cell. Virus is shed in respiratory secretions for 5–10 days. [*]

The incubation period for influenza is usually 2 days, but
can vary from 1 to 4 days. The severity
of influenza illness depends on the prior immunologic experience with
antigenically related virus variants. In general, only about 50% of
infected persons will develop the classic clinical symptoms of influenza. [*]

Systemic symptoms and
fever usually last from 2 to 3 days, rarely more than 5 days. [*]

Transmission:

Humans are the only known reservoir of influenza types B and
C. Influenza A may infect both humans and animals. [*]

Influenza is primarily transmitted from person to person via
large virus-laden droplets (particles more than 5 microns in diameter) that are
generated when infected persons cough or sneeze. These large droplets can then
settle on the mucosal surfaces of the upper respiratory tracts of susceptible
persons who are near (within 3 feet) infected persons. [*]

Transmission may also occur through direct contact or
indirect contact with respiratory secretions such as when touching surfaces
contaminated with influenza virus and then touching the eyes, nose or mouth. [*]

Adults can transmit influenza from the day before symptom
onset to approximately 5 days after symptoms begin. Children can transmit
influenza to others for 10 or more days. [*]

Peak influenza activity in the United States occurred most frequently in January and
February. [*]

Persons 65 years
of age and older account for approximately 90% of deaths attributed to
influenza. [*]

Protection from the
vaccine:

Multiple manufacturers produce inactivated influenza vaccine
each year for the U.S. market. [*]

Immunity following
inactivated influenza vaccination is less than 1 year because of waning of
vaccine-induced antibody and antigenic drift of circulating influenza viruses. [*]

At best, vaccines might be effective against only influenza A and B,
which represent about 10% of all
circulating viruses[*]

In children under the age of two, the efficacy of inactivated
vaccine was similar to placebo. [*]

Analysis of safety data from influenza vaccines (in children)
is not able to be reviewed due to the lack of standardization in the
information published, but very little
information was found on the safety of inactivated vaccines, the most
commonly used vaccine in young children. [*]

Influenza vaccines were associated with serious harms such as
narcolepsy and febrile convulsions. [*]

There is no evidence that the influenza vaccine decreases
complications, such as pneumonia, or transmission.[*]

The inactivated influenza vaccine has been documented (2012)
in resulting in 5.5 timesmore incidents of respiratory illness in vaccinated
individuals.This phenomenon is
known as virus interference.[*]

Treatment:

In the majority of cases, nothing more than bed rest and
plenty of fluids is recommended for treatment of influenza. In some cases, you
may be prescribed an antiviral medication, such as oseltamivir (Tamiflu) or
zanamivir (Relenza).[*][*]

Measles

We currently decline to vaccinate against the measles virus. This
is for several reasons….

The current incidence rate in the US (0.7 per 1 million population) islow.

While I understand that approximately 30% of reported measles
cases do have at least one complication reported, I also know that the most common
reaction reported is diarrhea.

We understand that severe complications from measles canbe avoided though supportive care that ensures good nutrition, adequate
fluid intake and treatment of dehydration.[*]

On a personal note, I have witnessed a severe adverse
reaction to this vaccine (thrombocytopenia).
While I can comprehend that the risk of this reaction (or any other severe
reaction) from this vaccine is considered low, I must admit that experiencing
first hand a severe reaction in a young child against MMR is quite numbing. In my opinion, the risk is not worth it.

-Acute illness and rash: the rash is consists of small
red spots, some of which are slightly raised. The face breaks out first,
particularly behind the ears and along the hairline. Over the next few days,
the rash spreads down the arms and trun. At the same time, fever rises sharply,
often as high as 104 or 105 F (40 or 40.6 C). The measles rash gradually
recedes, fading first from the face and last from the thighs and feet. [*]

-Communicable period (8 days): a person with measles
can spread the virus to others for about eight days, starting four days before
the rash appears and ending when the rash has been present for four days. [*]

People who don't have enough vitamin A in their diets are more likely to contract measles and to have
more-severe symptoms.[*]

Transmission:

The highly contagious virus is spread by coughing and
sneezing, close personal contact or direct contact with infected nasal or
throat secretions. [*]

The virus remains active and contagious in the air or on
infected surfaces for up to two hours. It can be transmitted by an infected
person from four days prior to the onset of the rash to four days after the
rash erupts. [*]

Risk/Prevalence:

Worldwide, there are estimated to be 20 million cases (with more
than half of all deaths associated with measles occur in India).[*]

Before 1963, more than 50% of persons had measles by age 6,
and more than 90% had measles by age 15.[*]

In 2000, the United States
achieved measles elimination (defined as interruption of year-round endemic
measles transmission).

During 2011, a total of 222 measles cases (incidence rate: 0.7 per 1 million
population) were reported to CDC.[*]

The majority of cases are now imported from other countries
or linked to imported cases. Most
imported cases originate in Asia and Europe and occur both among U.S. citizens
traveling abroad and persons visiting the United States from other countries.

Approximately 30% of reported measles cases have one or more
complications (diarrhea was reported in
8% of measles cases, making this the most commonly reported complication of
measles). Complications of measles are more common among children younger
than 5 years of age and adults 20 years of age and older.

The overwhelming majority (more than 95%) of measles deaths
occur in countries with low per capita incomes and weak health
infrastructures.[*]

No deaths caused by the measles virus were reported for 2011
in the US. [*]

Measles is more severe
in malnourished children, particularly those with vitamin A deficiency. Complications include
diarrhea, dehydration, stomatitis, inability to feed, and bacterial infections
(skin and elsewhere).

Protection from the
vaccine:

The measles vaccine
produces a mild, noncommunicable infection. Measles antibodies develop in
approximately 95% of children vaccinated at 12 months of age and 98% of
children vaccinated at 15 months of age.[*]

Approximately 2%–5% of children who receive only one dose of
MMR vaccine fail to respond to it. MMR vaccine failure may occur because of
passive antibody in the vaccine recipient, damaged vaccine, incorrect records,
or possibly other reasons. Most persons who fail to respond to the first dose
will respond to a second dose. [*]

Although the titer of vaccine-induced antibodies is lower than that following natural disease,
both serologic and epidemiologic evidence indicate that vaccine-induced immunity appears to be long-term. [*]

Fever is the most common adverse reaction following MMR
vaccination. Although measles, mumps, and rubella vaccines may cause fever
after vaccination, the measles component
of MMR vaccine is most often associated with this adverse reaction. After
MMR vaccination, 5% to 15% of susceptible persons develop a temperature of
103°F (39.4°C) or higher, usually occurring 7 to 12 days after vaccination and
generally lasting 1 or 2 days. Most persons with fever are otherwise
asymptomatic. [*]

Measles- and rubella-containing vaccines, including MMR, may
cause a transient rash. Rashes, usually appearing 7 to 10 days after MMR or
measles vaccination, have been reported in approximately 5% of vaccinees. [*]

Rarely, MMR vaccine may cause thrombocytopenia
within 2 months after vaccination (I personally know someone who has suffered
this reaction one week following this vaccine). Estimates of the frequency of
clinically apparent thrombocytopenia from Europe are one case per 30,000–40,000
vaccinated susceptible persons, with a temporal clustering of cases occurring 2
to 3 weeks after vaccination. The clinical course of these cases was usually
transient and benign, although hemorrhage occurred rarely. [*]

Treatment:

Severe complications from measles canbe avoided though
supportive care that ensures good nutrition, adequate fluid intake and
treatment of dehydration.[*]

Maintain bedrest and provide quiet activities for children.
If there is sensitivity to light, keep room darkly lit.[*]

Remove eye secretions with warm saline or water and encourage
children not to rub eyes. [*]

People who don't have enough vitamin A in their diets are
more likely to contract measles and to have more-severe symptoms.[*]

Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%. [*]

Mumps

We decline this vaccine because mumps is generally a benign
self-limited disease that produces lifelong immunity with severe side effects beign
extremely rare.[*]

The number of mumps cases has dropped dramatically in the US,
so the odds of getting mumps is low. Considering this and that 70% of cases of
mumps are asymptomatic or have nonspecific symptoms, we decline the MMRII/MMR-V.
[*]

Also, the effectiveness of the mumps component of the
MMRII/MMRV depends on wild-type mumps (unvaccinated individuals) to provide
boosters throughout life. Because of this, (and the growing evidence of waning immunity over time) mumps
outbreaks among vaccinated populations
are reported world-wide.

Routine vaccination: administer the first dose of MMR
II vaccine at age 12 through 15 months, and the second dose (MMR II or MMR-V)
at age 4 through 6 years.

Administer 1 dose of MMR vaccine to infants aged 6 through 11
months before departure from the United States for international travel.

The Disease:

Mumps is a viral infection that primarily affects the parotid
glands — one of three pairs of saliva-producing (salivary) glands, situated
below and in front of your ears. If you or your child contracts mumps, it can
cause swelling in one or both parotid glands. [*][*]

The incubation period of mumps is 14 to 18 days (range, 14 to
25 days). Onset of mumps infection include symptoms that are nonspecific, and
include headache, low-grade fever, body weakness and muscle pain. [*]

As many as 20% of mumps
infections are asymptomatic. In an addition to that, 40% to 50% may have only
nonspecific or primarily respiratory symptoms. [*]

Parotitis (inflammation of one or both parotid glands, the
major salivary glands located on either side of the face, in humans)is the most common manifestation and occurs
in 30% to 40% of infected persons. Symptoms
tend to decrease after 1 week and usually resolve after 10 days. [*]

Central nervous system (CNS) involvement in the form of
aseptic meningitis occurs asymptomatically
in 50% to 60% of patients. Symptomatic
meningitis (headache, stiff neck) occurs in up to 15% of patients and resolves
in 3 to 10 days. Adults are at higher risk for this complication than are
children, and boys are more commonly affected than girls (3:1 ratio). [*]

Orchitis (testicular inflammation) is the most common
complication in postpubertal males. It occurs in as many as 50% of postpubertal
males. Pain and swelling may subside in 1 week, but tenderness may last for
weeks. Approximately 50% of patients with orchitis have some degree of
testicular atrophy, but sterility is rare. [*][*]

Oophoritis (ovarian inflammation) occurs in 5% of
postpubertal females. It may mimic appendicitis. There is no relationship to impaired fertility. [*]

Although it has not
been proved, contracting mumps while you're pregnant, especially early on,
may lead to miscarriage. [*]

Transmission:

Mumps is a human disease. Although persons with asymptomatic
or nonclassical infection can transmit the virus, no carrier state is known to
exist. [*]

Mumps is spread through airborne transmission or by direct
contact with saliva. [*]

Risk/Prevalence:

Mumps outbreaks still occur in the United States, and mumps
is still common in many parts of the world. [*][*]

The number of mumps cases has dropped dramatically in the US,
so the odds of getting mumps is low. Complications
of mumps, such as hearing loss, are potentially serious, but rare (approximately
1 per 20,000 reported cases). [*][*]

Protection from the
vaccine:

Pertaining to the mumps component on the MMR II vaccine, the
effectiveness of 1 dose declined from 96% in 2-year-olds to 66% in 11- to
12-year-olds. Theeffectiveness of 2 doses declined from 99% in
5- to 6-year-olds to 86% in 11- to 12-year-olds. [*]

There is growing evidence of waning immunity over time and mumps outbreaks among vaccinated populations are reported
world-wide.[*][*]

The risk to my daughter health from rubella infection is extremely
low considering rubella presents symptoms that are so mild that treatment
usually isn't necessary.

The signs and symptoms of rubella are often so mild that
they're difficult to notice.

Prevention of CRS (congential
rubella syndrome) is the main objective of rubella vaccination. Congenital
rubella occurs when the rubella virus in
a pregnant mother affects the developing baby in the first 3 months of
pregnancy. After the fourth month, the mother's rubella infection is less
likely to harm the developing baby.

My daughters are too young to become pregnant at this time.
This disease/vaccine is not relevent to their
wellness. When they are older and can have children, they will have the power
to decide if they want to be vaccinated against rubella.

Routine vaccination: administer the first dose of MMR
II vaccine at age 12 through 15 months, and the second dose (MMR II or MMR-V)
at age 4 through 6 years.

Administer 1 dose of MMR vaccine to infants aged 6 through 11
months before departure from the United States for international travel.

The Disease:

Rubella, also called German measles or three-day measles, is a contagious viral infection best known by
its distinctive red rash.[*]

Rubella is not the same as measles (rubeola), though the two
illnesses do share some characteristics, including the red rash. However,
rubella is caused by a different virus than measles and is neither as
infectious nor usually as severe as measles. [*]

The signs and symptoms
of rubella are often so mild that they're difficult to notice (up to 50% of
infections may be subclinical or inapparent), especially in children. If signs and symptoms do occur, they
generally appear between two and three weeks after exposure to the virus. [*]
[*]

In older children and adults, there is often a 1 to 5 day
prodrome (early onset symtpoms) with low-grade fever, malaise, and upper
respiratory symptoms preceding the rash. The rash usually occurs initially on
the face and then progresses from head to foot. It lasts about 3 days. The rash
is fainter than measles rash and does not coalesce. [*]

Prevention of CRS
(congential rubella syndrome) is the main objective of rubella vaccination
programs in the United States. [*]

Transmission:

Rubella is a human disease. There is no known animal
reservoir. Although infants with CRS may shed rubella virus for an extended
period, a true carrier state has not been described. [*]

Rubella is spread from person to person via airborne
transmission or droplets shed from the respiratory secretions of infected
persons. Rubella may be transmitted by persons with subclinical or asymptomatic
cases (up to 50% of all rubella virus infections). [*]

Rubella is only moderately contagious. The disease is most
contagious when the rash first appears, but virus may be shed from 7 days
before to 5–7 days or more after rash onset. [*]

Infants with CRS (congential
rubella syndrome) shed large quantities of virus from body secretions for
up to 1 year and can therefore transmit rubella to persons caring for them who
are susceptible to the disease. [*]

Risk/Prevalence:

Prevention of CRS (congential rubella syndrome) is the main
objective of rubella vaccination. [*]

Deafness is the most
common and often the sole manifestation of congenital rubella infection, especially after the
fourth month of gestation. Manifestations of CRS may be delayed from 2 to 4
years. [*]

Since 1997, the mothers of the majority of infants with CRS
were Hispanic women, many of whom were born in Latin American or Caribbean
countries where rubella vaccine is routinely not used or has only recently
begun to be used. [*]

Many rash illnesses can mimic rubella infection, and as many
as 50% of rubella infections may be subclinical/asymptomatic. [*]

Several reports indicate
that reinfection following exposure may occur in vaccinated persons who have low levels of
detectable antibody. The frequency and
consequences of this phenomenon are unknown. [*]

Rarely, clinical reinfection and fetal infection have been
reported among women with vaccine-induced immunity. Rare cases of CRS have
occurred among infants born to women who had documented serologic evidence of
rubella immunity before they became pregnant. [*]

Although vaccine virus may be isolated from the pharynx,
vaccinees do not transmit rubella to others, except occasionally in the case of the vaccinated breastfeeding woman. In
this situation, the infant may be infected, presumably through breast milk, and
may develop a mild rash illness. [*]

Joint symptoms, such as arthralgia (joint pain) and arthritis
(joint redness and/or swelling), are associated with the rubella component of
MMR II. [*]

When acute joint symptoms occur, or when pain or paresthesias
not associated with joints occur, the symptoms generally begin 1–3 weeks after
vaccination, persist for 1 day to 3 weeks. [*]

Rarely, transient peripheral neuritic complaints, such as
paresthesias and pain in the arms and legs, have been reported. [*]

Treatment:

No treatment will shorten the course of rubella infection,
and symptoms are so mild that treatment
usually isn't necessary.[*]

Support of an infant born with congenital rubella syndrome
varies depending on the extent of the infant's problems. [*]

Tell friends, family and co-workers — especially pregnant
women — about your diagnosis if they may have been exposed to the disease. [*]

Varicella

Chickenpox

My daughters are
healthy and are not considered high-risk for complications from varicella.

In healthy children,
chickenpox typically requires no medical treatment at all, with the clinical
course being generally mild.

Complications are
infrequent among healthy children.

We choose to decline
this vaccine because we understand that the vaccine efficacy depends on the
circulation of wild-type chickenpox infection.

With
varicella, we are in a precarious situation. Since contracting the wild-type
strain of chickenpox is extremely limited, when a a child is vaccinated (which
will lay dormant in their nervous system) in hopes of a child become immune or elciting
a more mild reaction then they would in adulthood - we are setting them up in an environment that does not offer boosters
throughout life (unless you become dependent on more vaccine boosters).

We also understand
that as a result of the
implementation of a varicella vaccination program, shingles incidence is
expected to increase (a much more serious infection than chickenpox).Studies have demonstrated that the vaccine viruscan become latent
and laterreactivate to cause
shingles in both healthy and immunocompromised persons/children.[*]

We currently decline
this vaccine. As with all the vaccines listed here, my daughters will have the
opportunity to choose whether or not to vaccinate themselves when they are
older and understand the risk/benefits of the disease and vaccine.

(I would like to
note that I do not support ‘chickenpox
parties’. I write about my reasons here.)

Chickenpox
(varicella) is a viral infection by the varicella zoster virus (VZV) that
causes an itchy, blister-like rash. [*][*]

The recurrent
infection (herpes zoster, aka shingles) has been recognized since ancient
times. Primary varicella infection (chickenpox) was not reliably distinguished
from smallpox until the end of the 19th century. [*]

The clinical course in healthy children is
generally mild, with malaise, pruritus (itching), and temperature up to
102° for 2 to 3 days. Adults may have more severe disease and have a higher
incidence of complications. Respiratory and gastrointestinal symptoms are
absent. [*]

Varicella is a human
disease. No animal or insect source or vector is known to exist. [*]

Infection with VZV
occurs through the respiratory tract. The most common mode of transmission of
VZV is believed to be person to person from infected respiratory tract
secretions. Transmission may also occur by respiratory contact with airborne
droplets or by direct contact or inhalation of aerosols from vesicular fluid of
skin lesions of acute varicella or zoster. [*]

The period of
communicability extends from 1 to 2 days before the onset of rash through the
first 4 to 5 days, or until lesions have formed crusts. [*]

Varicella is highly
contagious. It is less contagious than measles, but more so than mumps and
rubella. [*]

Chickenpox is highly
contagious to people who haven't had the disease nor been vaccinated against
it. Before routine chickenpox vaccination, virtually all people had been
infected by the time they reached adulthood. [*]

Some data suggest
that in tropical areas, varicella infection occurs more commonly among adults
than children. The reason(s) for this difference in age distribution are not
known with certainty, but may be related to lack of childhood varicella
infection in rural populations. [*]

The estimated death rate for chicken pox is 1.4 per
100,000 cases (0.000014%) in normal children, but rises to 30.9 deaths per
I 00,000 cases (0.0309 %) in adults. The death rate is 7% in children with
leukemia. [*]

Secondary bacterial
infections of skin lesions with Staphylococcus or Streptococcus are the most
common cause of hospitalization and outpatient medical visits. [*]

Complications are infrequent among
healthy children. They occur much more frequently in persons older
than 15 years of age and infants younger than 1 year of age. Adults account for
only 5% of reported cases of varicella but approximately 35% of mortality. [*]

The push to research
and license the varicella vaccine stems
from the complication and mortality rate among high-risk persons. [*]

These groups include
children with leukemia, or persons receiving steroids, e.g., patients with
cancer, arthritis, kidney disease, organ transplants, or asthma. Steroids are known to suppress immunity,
leaving the patient sometimes defenseless against what would normally be
harmless diseases. Immunocompromised persons comprise only an estimated 0.
1% of all chicken pox cases. [*]

About 15 to 20% of healthy
vaccinated children will develop breakthrough varicella (breakthrough varicella
is defined as disease with symptom onset that occurs >42 days after
vaccination).
[*]

The transmission rate for breakthrough cases
caused by the vaccine is comparable to that for unvaccinated cases. [*]

If you've had chickenpox
or the varicella vaccine, you are at risk of shingles. [*]

Shingles can lead to
its own complication — a condition in which the pain of shingles persists long
after the blisters disappear. This complication, called postherpetic neuralgia,
can be severe. [*]

The virus is thought
to be more common in older adults and people with weakened immune systems. [*]

Two
studies utilizing mathematical models predicted that if exposure to wild-type varicella is important in maintaining immunity
to varicella and shingles, the shingles
incidence will increase in the short to medium term (over 10 to 40 years
and up to 70 years) as a result of
the implementation of a varicella vaccination program. [*]

One
study estimated that boosting due to exposure to wild-type varicella (which is
lost once the vaccination program started) could last up to an average of 20
years. [*]

Studies
have demonstrated that the vaccine virus
can become latent and later reactivate to cause herpes zoster in
both healthy and immunocompromised persons.[*]

In otherwise healthy
children, chickenpox typically requires
no medical treatment. Your doctor may prescribe an antihistamine to relieve
itching. But for the most part, the disease is allowed to run its course. [*]

Don't give anyone
with chickenpox — child or adult — any medicine containing aspirin because this
combination has been associated with a condition called Reye's syndrome.[*]

Hepatitis A

Hep A

My daughters do not possess
an increased risk of hepatitis A (such as a man who has sexual contact with
other men, are HIV positive, or use injected illicit drugs).

If they did somehow
contract Hep A, the symptomatic
illness is directly related to age.
In children younger than 6 years of age, the majority of infections are
asymptomatic.

Routine
vaccination includes 2-dose Hep A vaccine series for children starting at age
12 months followed by a second dose 6-18 months later.

The
Disease:

Hepatitis A is a
highly contagious liver infection caused by the hepatitis A virus. The
hepatitis A virus is one of several types of hepatitis viruses that cause
inflammation that affects your liver's ability to function. [*]

HAV
infection is acquired primarily by the fecal-oral route by either
person-to-person contact or ingestion of contaminated food or water. Because
the virus is present in blood during the illness prodrome, HAV has been
transmitted on rare occasions by transfusion. [*]

The
incubation period of hepatitis A is approximately 28 days (range 15–50 days).
The clinical course of acute hepatitis A is indistinguishable from that of
other types of acute viral hepatitis. The illness typically has an abrupt onset
of fever, malaise, anorexia, nausea, abdominal discomfort, dark urine and jaundice.
Clinical illness usually does not last longer than 2 months, [*]

Children generally have
asymptomatic or unrecognized illnesses,
so they may serve as a source of infection[*]

Practicing good hygiene — including
washing your hands often — is one of the best ways to protect against hepatitis
A. [*]

Risk/Prevalence:

In
the prevaccine era, hepatitis A caused
about 100 deaths per year in the United States. The case-fatality rate
among persons of all ages with reported cases was approximately 0.3%[*]

-Receive
clotting-factor concentrates for hemophilia or another medical condition

The
likelihood of symptomatic illness from HAV infection is directly related to age. In children younger than 6 years of age,
70% infections are asymptomatic. [*]

In
older children and adults, infection is usually symptomatic, with jaundice
occurring in more than 70% of patients. [*]

In rare cases, hepatitis A can cause acute
liver failure, which is a loss of liver function that occurs suddenly. People
with the highest risk of this complication include those with chronic liver
diseases and older adults. Acute liver failure requires hospitalization for
monitoring and treatment. [*]

Protection
from the vaccine:

Both
vaccines are highly immunogenic. More than 95% of adults will develop
protective antibody within 4 weeks of a single dose of either vaccine, and
nearly 100% will seroconvert after receiving two doses. [*]

Data concerning the long-term
persistence of antibody and immune memory are limited because the current vaccines
have been available only since 1995 and 1996. Estimates of antibody persistence
derived from kinetic models of antibody decline indicate that protective levels
of anti-HAV could be present for 20 years or longer. Other mechanisms (e.g.,
cellular) may contribute to long-term protection, but this is unknown. The need for booster doses will be determined by postmarketing surveillance
studies. [*]

For
both vaccines, the most commonly reported adverse reaction following
vaccination is a local reaction at the site of injection. Injection site pain,
erythema, or swelling is reported by 20% to 50% of recipients. [*]

Treatment:

Mild cases of
hepatitis A don't require treatment, and most
people who are infected recover completely with no permanent liver damage.
[*]

No specific treatment exists for
hepatitis A. Your body will clear the hepatitis A virus on its own. In most cases of
hepatitis A, the liver heals completely in a month or two with no lasting damage.
[*]

Immune
globulin (IG) is typically used for postexposure prophylaxis of hepatitis A in
susceptible persons.[*]

Small studies of
milk thistle treatment for liver disease have shown mixed results. Many of the
studies have been poorly designed, making it difficult for researchers to draw
conclusions about the usefulness of milk thistle. [*]

Bacterial
Meningitis

(Groups
A, C, Y and W-135)

My
daughters are not yet old enough to be vaccinated for meningococcal.

I
include the following information for those of you that do have children 11 yrs
or older.

Meningococcal
conjugate vaccine is recommended for infants and children with certain health
conditions, however the two-dose series starts for all healthy children at age
11 years with a second booster at age 16 years.

Adolescents aged 11
through 18 years with human immunodeficiency virus (HIV) infection should
receive a 2-dose primary series of MCV4, with at least 8 weeks between doses.

A handful of
serotypes are associated with most cases of meningococcal disease, whereas
other serotypes within the same serogroup rarely cause disease.[*]

The disease
meningitis is caused by a number of different bacteria and viruses. Bacterial
causes include Haemophilus influenzae, Escherichia coli, Streptococcus
pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, and Neisseria
meningitidis. Although a variety of cocci cause meningitis, the term
meningococcus is reserved for the Gram-negative, bean-shaped diplococcus,
Neisseria meningitidis. [*]

The incubation
period of bacterial meningococcal disease is 3 to 4 days, with a range of 2 to
10 days. [*]

Meningitis
is an inflammation of the membranes (meninges) surrounding your brain and
spinal cord. [*]

The
swelling associated with meningitis often triggers the "hallmark"
signs and symptoms of this condition, including headache, fever and a stiff
neck. [*]

Meningitis
typically results from contagious infections. Common bacteria or viruses that
can cause meningitis can spread through coughing, sneezing, kissing, or sharing
eating utensils, a toothbrush or a cigarette. You're also at increased risk if
you live or work with someone who has the disease. [*]

Humans are the only
natural reservoir of meningococcus. As many as 10% of adolescents and adults
are asymptomatic transient carriers of N. meningitidis, most strains of which
are not pathogenic [*]

Primary mode is by
respiratory droplet spread or by direct contact. [*]

Between 5 and 30% of
normal individuals are carriers at any given time, yet few develop meningococcal disease. Carriage rates are highest
in older children and young adults. [*]

Meningococcal
meningitis occurs both sporadically (mainly groups B and C meningococci) and in
epidemics (mainly group A meningococci), with the highest incidence during late
winter and early spring. [*]

Meningococcal disease
occurs throughout the year, However, the incidence is highest in the late
winter and early spring. [*]

The communicability
of N. meningitidis is generally limited. In studies of households in which a
case of meningococcal disease has occurred, only 3%–4% of households had
secondary cases. [*]

Risk/Prevalence:

Prior to 2000, an
estimated 1,400 to 2,800 cases of meningococcal disease occurred each year in
the United States, a rate of 0.5 to 1.1 per 100,000 population. [*]

Most
cases of meningitis in the U.S. are caused by a viral infection, but bacterial
infections also can lead to meningitis. [*]

Bacterial
meningitis commonly affects people under 20, especially those living in
community settings. [*]

Infants with
meningococcal meningitis rarely display signs of meningeal irritation.
Irritability and refusal to take food are typical; vomiting occurs early in the
disease and may lead to dehydration. Fever is typically absent in children
younger than 2 months of age[*]

In older children
and adults, specific symptoms and signs are usually present, with fever and
altered mental status the most consistent findings. [*]

Factors that may compromise
your immune system — including AIDS, alcoholism, diabetes and use of
immunosuppressant drugs — also make you more susceptible to meningitis. Removal of your spleen, an
important part of your immune system, also may increase your risk. [*]

Large outbreaks of
serogroup A meningococcal disease occur in the African “meningitis belt,” an
area that extends from Ethiopia to Senegal. Rates of endemic meningococcal
disease in this area are several times higher than in industrialized countries.
In addition, outbreaks occur every 8–12 years with attack rates of 500–1000
cases per 100,000 population. [*]

Protection
from the vaccine:

A peak in disease
incidence among persons 18 to 21 years of age persists, even after routine vaccination of adolescents was recommended in
2005. From 2000–2004 to 2005–2009, the estimated annual number of cases of
serogroups C and Y meningococcal disease decreased 74% among persons aged 11
through 14 years but only 27% among
persons aged 15 through 18 years. [*]

Cases of
meningococcal disease caused by serogroups C and Y among persons who were
vaccinated with meningococcal conjugate vaccine have been reported. In 2010,
CDC received 12 reports of serogroup C or Y meningococcal disease among persons
who had received a meningococcal conjugate vaccine. The mean age of these
persons was 18.2 years (range: 16 through 22 years). The mean time since
vaccination was 3.25 years (range: 1.5–4.6 years). [*]

Two meningococcal
conjugate vaccines are licensed in the United States. [*]

A protective level
of antibody is usually achieved within 7–10 days of vaccination. Among infants and children younger than 5
years of age, the level of antibody against serogroup A and C polysaccharide
decreases substantially during the first 3 years following a single dose of
vaccine. In healthy adults, antibody levels also decrease, but antibodies
are detectable as long as 10 years after vaccination. Although vaccine-induced
protection likely persists in school-aged children and adults for at least 3
years, the efficacy of the group A vaccine in children younger than 5 years of
age may decrease markedly within this period. In one study, efficacy declined
from more than 90% to less than 10% 3 years after vaccination among children
who were younger than 4 years of age when vaccinated. Efficacy was 67% among children who were older than 4 years of age at
vaccination.[*]

Treatment:

The
treatment depends on the type of meningitis you or your child has. [*]

Acute
bacterial meningitis requires prompt treatment with intravenous antibiotics
and, more recently, cortisone medications, to ensure recovery and reduce the
risk of complications, such as brain swelling and seizures. The antibiotic or
combination of antibiotics that your doctor may choose depends on the type of
bacteria causing the infection. Your doctor may recommend a broad-spectrum
antibiotic until he or she can determine the exact cause of the meningitis. [*]

Penicillin is the
drug of choice to treat meningococcemia and meningococcal meningitis. Although
penicillin does not penetrate the normal blood-brain barrier, it readily
penetrates the blood-brain barrier when the meninges are acutely inflamed. [*]

Many antibiotics are
effective for N. meningitidis infection, including penicillin. Few
penicillin-resistant strains of meningococcus have been reported in the United
States. Once N. meningitidis infection has been confirmed, penicillin alone is
recommended. [*]

Wash
your hands. Careful hand-washing is important to avoiding exposure to
infectious agents. Teach your children to wash their hands often, especially
before they eat and after using the toilet, spending time in a crowded public
place or petting animals. Show them how to wash their hands vigorously,
covering both the front and back of each hand with soap and rinsing thoroughly
under running water. [*]

Cover
your mouth. When you need to cough or sneeze, be sure to cover your mouth and
nose.[*]

Conclusion

I
have presented a brief list which was specific in referencing why we currently
decline the vaccines that are recommended by the ACIP for my daughters.

This
lists omits several other reasons which also provides confirmation to our
choice, I do this purposefully because these reasons only give support to the foundation understanding the disease (prevalence,
risk, transmission, treatment).

If
you are curious about vaccines, (from my own experience) I recommend learning
about the which diseases are recommended for your child by referencing the vaccine
schedule and then becoming educated about that disease. Once you have
accomplished this, you are more competent in weighing the choice of using a
vaccine in prevention.

Although this
list provides references throughout (from the CDC, WHO, MayoClinic and others),
please do not use this as medical advice. I continue to reexamine my vaccine choices.
I encourage you to continue your research as well